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How long do you recommend women take Arimidex (anastrozole) after being treated for aggressive breast cancer? Four years ago, at the age of 46, I was diagnosed with HER-2/neu, stage III-plus, ER/PR-positive breast cancer, node-positive (only two or three lymph nodes). Dose-dense chemo (doxorubicin and cyclophosphamide followed by four rounds of Taxol/paclitaxel) was followed by extensive daily radiation on the affected side of my chest, neck and armpit. The Arimidex has extended and exacerbated chemo-induced menopausal symptoms, and my oncologist seems to think that 10 years of aromatase inhibitors is warranted, despite the fact that it's been over four years with no recurrence of cancer. Is he being overly cautious? CT scans, PET scans and MRIs show no new growths. Thank you.

In general, the party line has been to consider five years of endocrine therapy, preferably with an aromatase inhibitor such as Arimidex for additional therapy of a HER-2/neu positive breast cancer that also expresses the estrogen receptor.

If the type of cancer you experienced recurs, it tends to do so within a few years of initial presentation and treatment. In this setting, the research is less clear about whether adding therapy beyond the standard five years will make a huge difference in the long-term.

For you, the most important consideration is weighing the risks of relapse against the known impact on your quality of life. It is one thing to live your life with the fear of recurrence but another to take a medicine that harms your quality of life while providing marginal — if any — benefit beyond the duration of time supported by research.

Although you didn’t ask, I’ll add that the ordering of routine surveillance PET scans and CT scans sounds like overkill. These tests are more likely to cause undue anxiety when something is detected, given that more “non-cancer” will be picked up than anything else. Furthermore, the radiation you are receiving with the CT scans can really add up over time.

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